Provider Demographics
NPI:1730076167
Name:BRANTLEY, ANFERNEE JORDAN
Entity type:Individual
Prefix:
First Name:ANFERNEE
Middle Name:JORDAN
Last Name:BRANTLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 W VERMONT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-4337
Mailing Address - Country:US
Mailing Address - Phone:989-778-0053
Mailing Address - Fax:
Practice Address - Street 1:200 S WENONA ST STE 195
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-8820
Practice Address - Country:US
Practice Address - Phone:313-497-2665
Practice Address - Fax:313-583-7002
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician